J Korean Surg Soc.  2004 Jan;66(1):60-63.

Spontaneous Pneumoperitoneum Secondary to the Rupture of a Gas-Containing Pyogenic Liver Abscess

• Kim HJ
• Jang HJ
• Cho YP
• Kim YH
• Jung SM
• Ahn JH
• Han MS

Abstract

Herein, a rare case of a spontaneous rupture of a liver abscess, resulting in pneumoperitoneum, is reported. A 71-year old female with uncontrolled diabetes mellitus, developed an acute abdomen. The chest x-ray and plain abdominal radiography findings revealed bilateral subphrenic free air, and the computed tomography suggested the rupture of a gas-containing pyogenic liver abscess in the left hepatic lobe, extending to the lesser omentum. An emergency laparotomy was performed, there was a ruptured pyogenic liver abscess in the left lobe, but no perforation of the hallow viscus organ. A left lobectomy of the liver, with surgical drainage, was performed. The occurrence of pneumoperitoneum secondary to the intraperitoneal rupture of a pyogenic liver abscess, is extremely rare. The condition is associated with high mortality as they are often misdiagnosis at a late stage as a hollow viscus perforation. Recently advances in computed tomography and ultrasound have resulted in liver abscesses being detect earlier. It must be borne in mind that a rupture of a gas-containing liver abscess can also mimic a perforation of the gastrointestinal tract.

Keyword

Rupture of a gas-containing pyogenic liver abscess; Pneumoperitoneum

MeSH Terms

Abdomen, Acute
Aged
Diabetes Mellitus
Diagnostic Errors
Drainage
Emergencies
Female
Gastrointestinal Tract
Humans
Laparotomy
Liver
Liver Abscess
Liver Abscess, Pyogenic*
Mortality
Omentum
Pneumoperitoneum*
Radiography, Abdominal
Rupture*
Rupture, Spontaneous
Thorax
Ultrasonography